In laparoscopic surgery, access is gained to an interior surgical site by making one or more short incisions in the body which extend down to the interior surgical site, and then inserting a hollow tube or cannula into each incision so that the cannulas can act as liners to hold the incisions open and thereby provide portals leading down to the interior surgical site. A laparoscopic procedure can then be performed by passing instruments (e.g. cutting devices, clamps, viewing apparatus, etc.) down the cannulas so that the distal working ends of the instruments can be positioned and used about the surgical site, while the proximal handle ends of the instruments remain outside the body where they can be manipulated by the surgeon.
Laparoscopic procedures frequently involve the repair and/or removal of tissue from the interior surgical site, and often require that some sort of closure be made to the tissue being operated upon. Such closure can be effected through the use of conventional needles and suture, surgical clips or staples, or other known closure means. In this respect, it has been found that the use of conventional needles and suture can have significant advantages in many laparoscopic procedures, since they generally allow the tension of the closure to be dynamically adjusted during suture deployment. At the same time, however, the use of conventional needles and suture can also present significant difficulties in laparoscopic surgery, on account of the limited access provided to, and at, the interior surgical site.
One aspect of using conventional needles and suture which can be particularly troublesome in a laparoscopic surgical setting is that of engaging and gripping the needles at the interior surgical site. Currently, surgeons typically use long forceps-type needle holders to reach into the interior surgical site and engage and grip the needle during suturing. Unfortunately, while such a needle holder may be adequate in conventional surgical settings where there is generally fairly direct physical and visual access to the surgical site, it tends to be less effective in laparoscopic surgical settings due to the remote nature of the surgical site, the limited cannula access provided to that site, and the limited space available at the surgical site.
In addition to the foregoing, conventional forceps-type needle holders tend to provide relatively little tactile feedback to the surgeon. As a result, the surgeon has no reliable way of gauging, and hence of varying, the degree of engagement between the forceps and the needle. In other words, due to the relatively little tactile feedback provided by forceps-type needle holders, the surgeon has difficulty reliably engaging the needle with anything other than a totally fixed engagement.
Furthermore, inasmuch as forceps-type needle holders use an opposing jaw design, there tends to be no way to slidably capture the needle to the needle holder during use; the needle is either securely captured by the needle holder or it is not captured at all by the needle holder.
Even more important than the foregoing, however, is the problem of needle rolling during suturing. More specifically, the surgical needles employed during laparoscopic surgery generally tend to be curved needles, and it is important that they be held securely by the needle holder during use so that the plane of the needle always remains substantially perpendicular to the longitudinal axis of the needle holder; this orientation allows the surgeon to effect suturing with a simple rotational movement of the wrist. Any rolling of the needle relative to the suture holder during suturing will cause the plane of the needle to shift away from the desired perpendicular position and thereby inhibit the preferred suturing motion. Unfortunately, however, with the opposing jaw design of conventional forceps-type needle holders, where the jaws open and close with a vertical motion, the flat jaws of the needle holder engage the curved needle in a top-bottom sort of engagement which is applied against the curvature of the needle's arc. As a result, only a limited engagement can be achieved between the needle holder and needle. This tends to allow the curved needle to roll relative to the needle holder. Stated another way, since conventional forceps-type needle holders grasp the needle with a top-bottom engagement against the curvature of the needle's arc, rather than with a front-back sort of engagement parallel to the plane of the curved needle, no stabilizing vertical surfaces are available to lock the needle against rolling during use. As a result, the needle can shift away from the desired perpendicular position during use and thereby inhibit the desired suturing motion.